药物铺灸联合ACBT技术对高原地区COPD稳定期患者呼吸和运动功能的影响

Effects of Drug Paving Moxibustion Combined with ACBT on Respiratory and Motor Functions of COPD Patients in Plateau Area

目的:探讨药物铺灸联合主动循环呼吸技术(ACBT)对高原地区慢性阻塞性肺疾病稳定期患者呼吸和运动功能的影响。方法:将45例符合纳入标准的COPD稳定期患者随机分为铺灸组,ACBT组、联合组,每组患者15例,各组患者均接受基础药物治疗。药物铺灸组选择补肺益气方药,研成细末铺在穴区,并放置姜艾连续施灸3壮(约50 min),每周治疗3次。ACBT组进行主动循环呼吸康复训练,包括呼吸控制、胸廓扩张运动和用力哈气等方案,3次/d,每次训练15~20min。联合治疗组结合两种治疗手段。所有患者连续治疗8周后进行疗效评定。分别测定各组患者治疗前后肺功能FEV1%、FEV1/FVC、RV/TLC,用力吸气末、用力呼气末时相膈肌厚度(DEFRC、DETLC)、膈肌移动分数(DTF),6min步行距离(6MWT),生活质量SGRQ问卷评分。结果:治疗8周后,DEFRC、DETLC、6MWT以及SGRQ指数均较治疗前提高(P<0.05),联合治疗组较治疗前有显著提高(P<0.01)。组间比较,联合组较单一治疗组对于上述指标有差异(P<0.05),比较铺灸组DEFRC指标有显著差异(P<0.01);对比ACBT组DETLC、SGRQ指数有显著差异(P<0.01)。针对FEV1%、FEV1/FVC、RV/TLC数值以及DTF与治疗前比较无差异,组间比较亦无统计学意义(P>0.05)。结论:铺灸和ACBT疗法可提高呼吸效率,提升运动耐力,改善生活质量,二者联合效果显著,优于单一治疗。但针对肺功能核心指标和膈肌增厚分数,三种治疗方案均无统计学意义。

Objective:To investigate the effect of drug-spreading moxibustion combined with active circulatory breathing technique(ACBT)on respiratory and motor function in patients with stable chronic obstructive pulmonary disease in plateau areas.Methods:Forty-five patients with stable COPD who met the inclusion criteria were randomly divided into a moxibustion group,an ACBT group,and a combined group,with 15 patients in each group,and each group received basic drug therapy.In the drug shop moxibustion group,the herbs for invigorating lung and Qi were selected,into fine powder and spread on the acupoint area,and placed ginger for 3 continuous moxibustion(about 50 min),3 times a week.The ACBT group received active circulatory respiratory rehabilitation training,including breathing control,thoracic expansion exercise,and forced breathing,3 times/d,15-20 min each time.The combination therapy group combined two treatments.All patients were evaluated for efficacy after 8 consecutive weeks of treatment.Pulmonary function FEV1%,FEV1/FVC,RV/TLC,diaphragm thickness(DEFRC,DETLC),diaphragm movement fraction(DTF),6-min walking distance(6MWT),quality of life SGRQ questionnaire score.Results:After 8 weeks of treatment,the indexes of DEFRC,DETLC,6MWT and SGRQ were all increased compared with those before treatment(P<0.05),and the combined treatment group was significantly improved(P<0.01).Compared with the single treatment group,the combination group had a difference in the above indexes(P<0.05),and the DEFRC index in the moxibustion group had a significant difference(P<0.01);compared with the ACBT group,there was a significant difference in DETLC and SGRQ index(P<0.01).There were no differences in FEV1%,FEV1/FVC,RV/TLC values and DTF compared with those before treatment,and there was no statistical significance between groups(P>0.05).Conclusion:Moxibustion and ACBT therapy can improve respiratory efficiency,improve exercise tolerance,and improve quality of life.The combined effect of the two is significant,which is better than that of single therapy.However,there was no statistical significance among the three treatment options for the core index of pulmonary function and the fraction of diaphragmatic muscle thickening.